Blood results. Hashis/cortisol/CH??

[Portia1974]

Hi All!

So, following on from this post:

healthunlocked.com/thyroidu...

Blood results are in.

Plasma Cortisol (140-690 nmol/L)

24/07/18 = 237

15/09/16 = 233

The general consensus on the last post that the level of 233 (from Sept 2016) was a tad low for a 9am cortisol and there was some discussion suggesting the range given might have been for the whole day rather than just a morning range. Print out from most recent test had this to say:

"Plasma cortisol levels show diurnal variation. As a guide, morning values will be in the range 140-690nmol/L and evening values in the range 70-350nmol/L"

Am a bit flummoxed by this. So by all accounts my readings would be considered normal at night time, but also normal for first thing in the morning??? Does not compute for me. Any thoughts?

Also, a query regarding Hashis which I thought had been deemed pretty unlikely by my previous results. Except, they appear (at least the TPO does as the other wasn't tested) to have increased since my last test. While still regarded as normal, this does suggest to me that something is occuring in a wax and wane kind of way, if only at a "sub clinical" level (Results in reverse order):

24th JULY 2018

Plasma TSH (0.3-5.6 mu/L)

1.46

Free T4 (12 - 22 pmol/L

) XXX

Free T3 (3.1 - 6.8 pmol/L)

XXX

TPO antibodies (0-60 IU/mL

) 33

TG Antibodies

(0-115 IU/mL) XXX

5th JULY 2018

Plasma TSH (0.3-5.6 mu/L)

4.73

Free T4 (12 - 22 pmol/L

) 11.8

Free T3 (3.1 - 6.8 pmol/L) 3.61

TPO antibodies (0-60 IU/mL

) <9

TG Antibodies (0-115 IU/mL) <10

At this stage I had taken no thyroid meds. Both tests performed fasting and first thing. So same conditions. So as my TSH has fallen my TPO has risen (or possibly vice versa). Any thoughts ??

The upshot of my meeting with the GP today was a referall to one of the Endos from the TUK list. With a view to further assessment regarding Central/Secondary Hypo. Despite what they are regarding as normal cortisol and prolactin results I pointed out that CH can impact TSH on it's own without other hormones being affected. And that if I had a pituitary dysfunction (including potentially an adenoma) then I felt that really, this is something I should know! (Despite cortisol and prolactin being normal). "absolutely" she says! I offer the name of the Endo from the list and she addressed the letter directly to him. I know that in our area though, people are waiting over a year from referall to appointment. So I've decided to start on the Levo and see what happens in the meantime.

I feel pretty strongly that CH is likely having now read up. But always interested to hear any insights you clever lot have to offer. Bloods in reverse order as follows (same ranges as before/above):

24th JULY 2018

Plasma TSH 1.46

Free T4 - not tested

Free T3 - not tested

5th JULY 2018

TSH 4.73

Free T4 11.8

Free T3 3.61

18th JUNE 2018

TSH 2.56

Free T4 13.5

Free T3 3.34

21st Feb 2018

TSH 4.43

Free T4 not tested

Free T3 not tested

These from 2014 and 2010 I now know to hint at a possible issue despite being told everything normal:

31st JULY 2014

TSH 1.21

Free T4 9.5

Free T3 not tested

23rd JUNE 2010

TSH 0.67

Free T4 9

Free T3 not tested

Having learnt alot from you all in the past few weeks, I think that 2010 result potentially shows a CH issue

going back that far. What would you all say? I'm starting to think this could be the answer to it all. The b12, iron, folate and vit d issues with absorption, fatigue, pain, fog. The lot.

Started on Levo today (50mcg). God I hope this helps! Have agreed with GP that I will organise full thyroid panel via medichecks in 8 weeks time and they will accept the results of that and dose based on a combo of symptoms and T3/T4 levels.

Fingers crossed.

[greygoose]

Am a bit flummoxed by this. So by all accounts my readings would be considered normal at night time, but also normal for first thing in the morning??? Does not compute for me. Any thoughts?

Remember, 'normal' only means 'in-range'. Your morning cortisol is in-range, but low. Morning cortisol is best up the top of the range. You don't give your night-time result, but if it's in-range, it's probably ok, because you don't need that much cortisol when you're trying to sleep.

This is the normal pattern of adrenal fatigue. The adrenals struggle to make enough cortisol early in the morning, when you need it the most to get you out of bed, and then continue to struggle throughout the day to make their daily quota. They probably manage that about mid-afternoon, and then production decreases. Is your night-time cortisol top of the range?

What you need to do is help your adrenals make more cortisol in the morning, but nourishing them - a high protein breakfast as soon as you rise. Plenty of vit C, B vits and salt. Get as much sleep as possible, and avoid stress as much as you can.

Your thyroid results from 2014/10 certainly do suggest Central hypo. Just a pity they didn't test FT3 to confirm.

[Portia1974 in reply to greygoose]

Thanks lovely! Apologies! I didn't actually have a night cortisol test! I was just saying (badly) that my morning cortisol reading looked more akin to a night time reading. My fault.

While it's crappy that the answers may have been there all along since that 2010 result, if only GPs knew or were bothered, it's actually a massive eureka moment for me. 10 years I've been deteriorating and at last I have what I think is a big piece of the puzzle. Even though I know there's no quick fix, I really feel like I can begin to rebuild my "jenga" tower now. (To now include adrenal support it seems! Thank you for that!) First dose of Levo today. Fingers crossed.

[greygoose in reply to Portia1974]

No, a night-time cortisol would be much lower than that - around 1 or something. And the top of the range would be something like 1.5. I've never seen an evening range go from 70 - 350. Not on here. Where did you get those ranges from, anyway?

[Portia1974 in reply to greygoose]

The guidance notes from the lab that were on the print out!

[greygoose in reply to Portia1974]

OK, well, of course, I forgot that what you're talking about is a serum cortisol. What we usually see on here are saliva cortisol results. But, who on earth does a night-time serum cortisol? lol It's hard enough to get a morning one. And the labs are closed!

[Portia1974 in reply to greygoose]

Ah okay!

[Portia1974 in reply to greygoose]

Also...did you have any thoughts on the TPO going from <9 to 33 in a couple of weeks? Still "normal" but really...should there be ANY antibodies at all?? The TPO rise coinciding with a drop in TSH? All very "sub clinical " I know. But scrutinising everything for clues!

[greygoose in reply to Portia1974]

Antibodies fluctuate all the time. Nothing surprising in that. And I doubt anything to do with the TSH.

Whether or not there should be any at all is a point people argue all the time. But, I don't think that question is answerable. Certainly having low antibodies doesn't completely rule out Hashi's, but it doesn't prove you have it, either. Maybe a ultrasound would show up any damage that might have been done, but the disease would be well advanced by then.

[Portia1974 in reply to greygoose]

Yup. Makes sense. Might chance my arm see if GP can request the ultrasound...but pretty sure she'll say wait for the endo appointment. Waiting list approx 12 months.

[greygoose in reply to Portia1974]

That's terrible!

[Portia1974 in reply to greygoose]

Yep. They have a waiting list to go on the waiting list (not even kidding). Pfft.

[greygoose in reply to Portia1974]

Oh dear!

[Hidden]

I would still say that your cortisol levels are low first thing in the morning, although the lab says that they are in range many Endo's would disagree. Have a look at this link for a chart showing the normal levels of cortisol throughout the day. It was compiles by Prof Peter Hindmarsh from hundreds of profiles taken, it clearly shows the levels of cortisol. He also states that "normal" people always have some cortisol in their body even over night. cahisus.co.uk/pdf/CIRCADIAN...

[greygoose in reply to Hidden]

But it is in range. No endo can argue with that. It's just that the result is very low in range and probably denotes adrenal fatigue. It's not low enough to be Addison's.

[Portia1974 in reply to greygoose]

It's not Addisons. Hypothetically speaking though (pun intended) IF there is a pituitary issue it could be preventing TSH and cortisol from being optimal, could it not? Suppressing both.

[Hidden in reply to Portia1974]

Yes you are right, if the problem is a problem with the pituitary then the adrenals will not function properly & neither will the TSH, for those of us with pituitary problems then T3 & T4 should be tested rather than TSH.